Federal Agency

HHS Office for Civil Rights (HIPAA Complaints)

HIPAA privacy violations, healthcare discrimination

Fax

+12024152720Verified

Phone800-368-1019

Best for

•Unlawful disclosure of health records
•Failure to provide medical records
•Healthcare discrimination

File HIPAA complaints about unlawful disclosure of health information or failure to provide records. Fax complaints to the HHS OCR national intake center.

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HHS Office for Civil Rights (HIPAA Complaints)

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Subject: Formal Demand — [MATTER_DESCRIPTION]

Notice text

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[TODAY_DATE]

To: [RECIPIENT_NAME]
    [RECIPIENT_ADDRESS]

Re: Formal Demand — [MATTER_DESCRIPTION]

Dear [RECIPIENT_NAME or "Sir or Madam"],

I am writing to formally demand [DEMAND — e.g., payment of $[AMOUNT], return of [PROPERTY], performance of [CONTRACT OBLIGATION], cessation of [CONDUCT]].

BACKGROUND
[FACTS — Describe the relevant facts in clear, chronological order. Include dates, amounts, agreements, and any prior attempts to resolve the matter.]

LEGAL BASIS
[LEGAL_CLAIM — State the legal basis for your demand. E.g., "Under our contract dated [DATE], you agreed to [OBLIGATION]. Your failure to perform constitutes a breach of contract." Or reference applicable law if known.]

DEMAND
Accordingly, I demand that you: [SPECIFIC_RELIEF]

I require your response and compliance no later than [DEADLINE — e.g., 14 days from the date of this letter].

If I do not receive a satisfactory response by the deadline, I will pursue all available legal remedies including, but not limited to, [REMEDIES — e.g., filing a complaint in [COURT], reporting to [AGENCY], seeking attorney's fees and costs].

This letter is sent as a formal notice and constitutes evidence of my demand. Please govern yourself accordingly.

Sincerely,

[SENDER_NAME]
[SENDER_ADDRESS]
[SENDER_PHONE]
[SENDER_EMAIL]

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